I passed my CPNE at Long Beach Memorial Hospital on Dec 9-11. I strongly recommend Tina's
workshop. She has wonderful lab there for you to practice. Excellent mnemonic those help to
assess and document for PCS. Tina's teaching power is Godgift. Everything that Tina teaches in the
class is exactly as it occured during Lab/PCS. I never forgot Tina's follow up during CPNE. Tina
helped me to pass my CPNE first try at Long Beach. Tina class teach us a systematic approach for
CPNE. Her wonderful husband was also there to help us with skills. I was confident due to Tina's
workshop. Thank you so much Tina!

Baldev,   (  drbaldevpatel@yahoo.com  )

Mnemonics can really help, especially during the exam when stress is
running high.  Yes, even for LVNs who have been doing assessments and
managements for many years.  Using mnemonics will force you to follow
procedural steps and not become victim to some of the bad habits and
shortcuts that you have picked up over the years.  For the purpose of the
clinical exam, you need to prove your expertise in the clinical skills the
“Excelsior way” or the way prescribed by nursing theory.  Moreover,
having the mnemonics on the back of your hand, will make you more
confident about your skills.  You will find it easier to perform all the steps
without forgetting crucial aspects of assessments or managements.  You
will also be able to jot them down on the grid in a matter of few minutes
and be ready for your evaluation phase.  When you are well-organized,
you will fly through the PCS without any problems.  

It is crucial that you register early for the clinical workshop.  When you
register for the workshop, I will mail you a handout with all the
mnemonics that you will be required to memorize before the class starts.  I
want everyone on the same page so no one will slow the other down.  I
recommend that you register for the class about 4 weeks before the start
date so I can mail out handouts and you have at least 2-3 weeks to get the
mnemonics down.  I know that some of you have made your own
mnemonics.  That is alright too, as long as you are positive that you are
not missing any of the critical elements.  I know everyone likes their own
mnemonics and so do I.  It is always easier for me as an instructor to have
a blank slate for your mind so I can fill it with all the pertinent and crucial
information for the clinical exam.

Example:  Abdominal Assessment

Abdominal assessment is usually assigned for patient who has undergone abdominal surgery
or has gastro-intestinal conditions.  Use simple language.  Don't say I'm going to do a
"peripheral vascular assessment" or "abdominal assessment" now.  Instead, say "I'm going to
check your feet now" or "I'm going to check your stomach/abdomen now".  Before doing the
assessment, make sure you turn the suction off.  Also assess the pain level.  Ideally you would
have already medicated the patient for pain a long time before abdominal assessment if incision
is present (ask for pain level right after the 20 minute check and medicate as needed).  
















4Ps --   P  P  P  P         S O D A          P O P       

P -       Privacy curtains (most hospitals have more than one patient to a room and
unnecessarily exposing the patient may cause emotional jeopardy)

P -      Pee (Does the Pt need to void?  Bladder may be distended which will interfere with
assessment.  Do this before you position the patient flat in bed otherwise you will have to
sit them up again before helping them get out of bed to the bathroom and lay them back
in bed again.  Do NOT make extra work for yourself.  In addition, if the patient has just had
abdominal surgery, repositioning them again and again can cause undue pain - physical
jeopardy)

P -       Position (“I’m going to lay you flat in bed.  Can you flex your knees?”  Pt flat in bed,
knees up.  Only exception is someone on O2/Resp problems—low fowlers.  You may
invoke CDM and you can tell the CE that you don’t want to compromise the patient’s
respiratory function, so you will leave the patient in low-fowler’s)

P -      Pain  (Is the Pt having any pain and where? … so you can invoke CDM if omitting a step.  
If patient is extremely fearful of touch around the incision site.  But it is very important to
do abdominal assessment especially if they’ve had surgery to see if tender or rigid as it
can clue to any complications.  If you’ve already given pain medication, hopefully its
already working by now.  Just explain the importance of the abdominal assessment.  But
don’t push it especially if the patient is really guarding the abdomen and doesn’t want
you to touch.  You cannot force the patient as it will cause emotional jeopardy)

S -   Suction Off

O -   Observe (Looking for distention, contour, size etc.. DO NOT TOUCH ABDOMEN, just lift the
gown and look.  DO NOT GO OUT OF ORDER since palpation of abdomen can stimulate
the bowel and result in increase of bowel sounds.  Also make a note of anything else you
see, including, incision, dressings, JP or other drains, colostomy/ostomy appliance, g-
tube etc.  You may chart on some of the following characteristics:  
S  A  C   S   A   C   S   Size, appearance, color, shape, and condition of skin)

D -    Don Gloves (Put gloves on if you think you will be come in contact with any body fluids
while auscultating or palpating the abdomen)

A -   Auscultate(Check sounds in all 4 quadrants with navel as intersecting point.. it is good to
listen a little away from the middle—the large intestine has more sounds – only touch
abdomen with stethoscope not with your hands.  Sounds can be classified as absent,
hypoactive (1-5/min), Active/Normal (6-30/min), Hyperactive (>30/min).  You should listen
over each quadrant for a full minute especially if they are absent to ensure that there are
some bowel sounds present.  After most surgeries, NPO is maintained until bowel
sounds return.  If sounds are different in each quadrant, make sure you document the
quadrants separately.)

P -      Palpate LIGHTLY 1-2 cms in all 4 quadrants.  You can invoke CDM and omit any
region if Pt complains of pain… Say before palpating – “Now I’m going to touch your
stomach.  Let me know if it feels tender when I touch”

O -     On Suction

P -      (Per Assignment measure Girth). Instead, substitute P=POOP, last BM? (According to the
16th edition, you will not be required to measure abdominal girth.  I have not removed the P out
of the mnemonics because after the CPNE, according to your workplace policy, you may still be
required to measure girth for patients with certain diagnosis. And don't forget:  It is still very
important that if your patient tells you that there are significant changes in his/her abdominal
girth according per their SELF REPORT, you still have to tell the staff nurse immediately of any
sudden changes according to the critical elements - any change in the patient's physical status
has to be reported... just don't forget girth just because it won't be assigned )
Iformation on this page is copyrighted.     ãContinuing Health Education
Comprehensive Mnemonics.    Easiest way to master all the Critical Elements !
Mnemonics
Jog your memory
with mnemonics
and Grid

ORGANIZE
YOURSELF!!!

This class will teach  
time management
and organization
skills necessary to
ace the exam!!